Anaesthesia
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Randomized Controlled Trial Clinical Trial
The effects of indomethacin on intracranial pressure and cerebral haemodynamics in patients undergoing craniotomy: a randomised prospective study.
We compared the effects of indomethacin (bolus of 0.2 mg.kg-1 followed by an infusion of 0.2 mg.kg-1.h-1) and placebo on intracranial pressure and cerebral haemodynamics in 30 patients undergoing craniotomy for supratentorial brain tumours under propofol and fentanyl anaesthesia. Indomethacin was given before induction of anaesthesia and the infusion was terminated after opening of the dura. Subdural intracranial pressure was measured through the first burr hole and before opening the dura. ⋯ Carbon dioxide reactivity measured after induction of anaesthesia was significantly lower in the indomethacin group (p < 0.05). After removal of the bone flap, no significant difference in carbon dioxide reactivity was observed. We suggest that these findings are explained by propofol-induced cerebral vasoconstriction.
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Thrombocytopenia in pregnant women can be associated with substantial maternal and neonatal morbidity. It may result from a range of conditions and early implementation of some specific treatment may improve both maternal and neonatal outcome. In this review we discuss the clinical features of the more common causes of thrombocytopenia associated with pregnancy, and provide an overview of the anaesthetic considerations.
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Tracheal airway pressures were measured via a transduced fibrescope during transtracheal jet ventilation in 10 patients. Ravussin transtracheal jet ventilation catheters were inserted under local anaesthesia. Following induction of general anaesthesia, tracheal airway pressures were measured at three anatomical levels during fibreoptic intubation. Overall pressure changes during transtracheal jet ventilation were small with the maximal pressure increase (13 mmHg) measured at the carina.
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The aim of this study was to investigate the pharmacokinetics of desflurane uptake into the brain and body by comparing desflurane concentrations in internal jugular-bulb blood (Jdes), arterial blood (Ades) and pulmonary arterial blood (PAdes) at a fixed inspired desflurane concentration. Thirteen patients (aged 42-72 years) undergoing coronary artery bypass grafting surgery were enrolled in this study. They were anaesthetised using a constant 5% inspired desflurane concentration (CIdes) during the first hour of anaesthesia. ⋯ It took 24 min for the Jdes to equilibrate with Ades. Both CIdes-CEdes and Ades-PAdes gradients persisted during the study period. There was no further uptake of desflurane into the brain after 24 min but there was near-constant uptake into the body.
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Angioedema of the face and neck is an uncommon but potentially life-threatening complication of angiotensin-converting enzyme (ACE) inhibitor therapy. This condition is of particular concern to the anaesthetist as it can rapidly progress to upper airway obstruction. We describe the presentation and management of five cases of ACE inhibitor related angioedema, all of which were associated with significant upper airway obstruction.